MEDICARE: ORLEANS CARDIOVASCULAR ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1467776088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLEANS CARDIOVASCULAR ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	2820 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6302
Country	:	US
Telephone Number	:	504-821-8158
Fax Number	:	504-304-1927

Provider Business Practice Location Address
First Line	:	2820 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6302
Country	:	US
Telephone Number	:	504-821-8158
Fax Number	:	504-304-1927

Authorized Official
Title or Position	:	MEMBER/AUTHORIZED OFFICIAL
Name	:	DR. GLENN M JOHNSON
Credential	:	M.D.
Telephone Number	:	504-469-3813

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	03/25/2010

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